A recent review suggests glaucoma secondary to intraocular tumor is an important diagnosis to consider in eyes with known tumor and those with unilateral or refractory glaucoma. The tumors that can produce glaucoma include iris melanoma, iris metastasis, iris lymphoma, trabecular meshwork melanoma, choroidal melanoma, choroidal metastasis, retinoblastoma and medulloepithelioma.
The authors note that the mechanisms that can lead to glaucoma can be multifactorial and involve solid tumor invasion into the angle, tumor seeding into the angle (pigment dispersion), angle closure and iris neovascularization. Depending on tumor type and location, the authors advise treating secondary glaucoma with medical management, transscleral cyclophotocoagulation, laser trabeculoplasty, anti-VEGF injections, minimally invasive glaucoma surgery (MIGS), filtering or shunting surgery or enucleation.
However, the review suggests surgeons avoid MIGS, filtering or shunting surgery in eyes with active malignant intraocular tumor to prevent tumor extension outside the globe. Instead, consider MIGS for eyes with treated, regressed posterior segment malignancy if there is no iris or ciliary body involvement. The authors assert that the management of tumor-induced secondary glaucoma is highly specific and depends on several factors related to the tumor and the glaucoma.
|Camp DA, Yadav P, Dalvin LA, Shields CL. Glaucoma secondary to intraocular tumors: mechanisms and management. Curr Opin Ophthalmol. December 12, 2018. [Epub ahead of print].|